Rahmanian Parwis B, Kaya Süreyya, Eghbalzadeh Kaveh, Menghesha Hruy, Madershahian Navid, Wahlers Thorsten
Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne, Cologne, Germany.
Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne, Cologne, Germany.
Ann Thorac Surg. 2018 Jan;105(1):24-30. doi: 10.1016/j.athoracsur.2017.07.047. Epub 2017 Nov 11.
The aim of this study was to evaluate the effects of rapid deployment aortic valve replacement (RDAVR) on surgical outcome and hemodynamics compared with standard aortic valve replacement (AVR).
One hundred sixty-three RDAVR patients (isolated, n = 67; combined with coronary artery bypass graft surgery [CABG], n = 96) were compared with a propensity matched control group (n = 163). Primary endpoints included association between valve type and procedure times, prosthesis size, transvalvular gradient, and indexed effective orifice area. Secondary endpoints were postoperative mortality and morbidity.
Aortic cross-clamp and cardiopulmonary bypass times in the RDAVR group were 55 ± 23 and 88 ± 38 minutes, respectively, compared with 77 ± 22 and 105 ± 38 minutes in the control group (p < 0.001). In the subgroup of patients undergoing isolated RDAVR (n = 67 of 163), the aortic cross-clamp and cardiopulmonary bypass times were 38 ± 13 and 66 ± 22 minutes, respectively, compared with 55 ± 14 and 81 ± 18 minutes in the control group (n = 67 of 163; p < 0.001). The RDAVR patients received larger prostheses (23.3 ± 1.8 mm) compared with standard AVR (22.8 ± 1.5 mm; p = 0.002). Mean transvalvular gradients and indexed effective orifice areas were 9 ± 5 mm Hg and 1.11 ± 0.11, respectively, in the RDVAR group compared with 13 ± 5 mm Hg and 0.95 ± 0.08 in the control group (p < 0.001). Hospital mortality was similar in both groups (1.8%, n = 3 of 163; p = 1.000). Postoperative pacemaker rates were 3.5% (n = 3 of 67) for isolated RDAVR versus 3.0% (n = 2 of 67; p = 0.649) for isolated AVR and 12.5% (n = 12 of 96) for RDAVR/CABG versus 4.2% (n = 4 of 96; p = 0.032) for AVR/CABG.
RDAVR facilitates reduced aortic cross-clamp and cardiopulmonary bypass times compared with standard AVR, particularly in patients undergoing concomitant procedures, allowing the use of larger prostheses and resulting in lower transvalvular gradients and higher indexed effective orifice area compared with standard AVR. Therefore, RDAVR may help to overcome patient-prosthesis mismatch in some patients.
本研究旨在评估与标准主动脉瓣置换术（AVR）相比，快速部署主动脉瓣置换术（RDAVR）对手术结果和血流动力学的影响。
将163例RDAVR患者（单纯手术，n = 67；联合冠状动脉旁路移植术[CABG]，n = 96）与倾向评分匹配的对照组（n = 163）进行比较。主要终点包括瓣膜类型与手术时间、人工瓣膜尺寸、跨瓣压差和指数化有效瓣口面积之间的关联。次要终点是术后死亡率和发病率。
RDAVR组的主动脉阻断时间和体外循环时间分别为55±23分钟和88±38分钟，而对照组分别为77±22分钟和105±38分钟（p<0.001）。在接受单纯RDAVR的患者亚组（163例中的67例）中，主动脉阻断时间和体外循环时间分别为38±13分钟和66±22分钟，而对照组（163例中的67例）分别为55±14分钟和81±18分钟（p<0.001）。与标准AVR（22.8±1.5mm）相比，RDAVR患者植入的人工瓣膜更大（23.3±1.8mm；p = 0.002）。RDVAR组的平均跨瓣压差和指数化有效瓣口面积分别为9±5mmHg和1.11±0.11，而对照组分别为13±5mmHg和0.95±0.08（p<0.001）。两组的医院死亡率相似（1.8%，163例中的第3例；p = 1.000）。单纯RDAVR术后起搏器植入率为3.5%（67例中的第3例），单纯AVR为3.0%（67例中的第2例；p = 0.649），RDAVR/CABG为12.5%（96例中的第12例），AVR/CABG为4.2%（96例中的第4例；p = 0.032）。
与标准AVR相比，RDAVR可缩短主动脉阻断时间和体外循环时间，尤其是在接受联合手术的患者中，允许使用更大的人工瓣膜，与标准AVR相比，可降低跨瓣压差并提高指数化有效瓣口面积。因此，RDAVR可能有助于克服某些患者的人工瓣膜-患者不匹配问题。
